Assisted reproduction techniques to combat female infertility

By (gynecologist) and (embryologist).
Last Update: 05/18/2021

Problems in a woman's fertility can have different origins depending on the point at which the alteration occurs. Thus, we can find problems due to ovarian endocrine factor, tubal factor (in the fallopian tubes), uterine factor and cervical factor (in the uterine cervix).

However, nowadays, one of the most common reasons for female infertility is advanced maternal age. The pace of life in today's society is conducive to delaying childbearing, which leads to a deterioration in female fertility due to a decrease in the number and quality of oocytes.

Despite this, the different assisted reproduction techniques can help, in many cases of female infertility, to achieve the desired pregnancy.

Indications for treatment

In order to choose the most appropriate female infertility treatment for each situation, the necessary fertility tests must be performed. This fertility study should be carried out on both the woman and the man, as there are times when the problem is not only the woman's or the man's problem, but both.

There are also situations in which the fertility tests in both partners are correct and, nevertheless, pregnancy is not achieved. These are cases of infertility of unknown origin (EOD).

Depending on the problem that causes female infertility and the woman's age, different assisted reproduction treatments may be indicated. These can be more or less complex, but they all have the same goal: to make it possible to get pregnant and have a healthy baby at home.

Assisted procreation, as any other medical treatment, requires that you rely on the professionalism of the doctors and staff of the clinic you choose. Obviously, each clinic is different. Get now your Fertility Report, which will select several clinics for you out of the pool of clinics that meet our strict quality criteria. Moreover, it will offer you a comparison between the fees and conditions each clinic offers in order for you to make a well informed choice.

Assisted reproduction and female infertility

The following are the main assisted reproduction techniques used for the treatment of infertility.

Artificial insemination (AI)

This assisted reproduction technique consists of introducing a seminal sample, previously processed in the laboratory, directly into the woman's uterus through the cervix. It should be noted that this technique is performed during the woman's ovulatory period, in order to increase the chances of gestation.

In order to be able to apply this assisted reproduction treatment, the degree of infertility of the patient must be mild. In addition, the woman should be no older than 35-38 years of age to ensure success.

On the other hand, it is a necessary requirement for the fallopian tubes to be functional in order to perform an AI, since it is in the tubes where the egg is kept waiting for the sperm. If the tubes are blocked, the union of egg and sperm cannot take place.

AI is used as a treatment in cases of female infertility in which the woman presents:

  • Mild endometriosis.
  • Ovulatory dysfunctions such as, for example, those caused by Polycystic Ovary Syndrome (PCOS).
  • Changes in the cervix (cervical factor).
  • EOD. In these cases where the reason for the couple's infertility is not known, the specialist may choose to begin performing AI.

However, AI is also used for women without a partner or for couples of women who wish to become pregnant and, in principle, do not have any infertility problems. In this case, AI would be performed with sperm from an anonymous donor.

The price of AI can be around 600-1000€, even reaching 1400€ if donor sperm is used. It is important to say that the price of additional medication is usually excluded from the budget.

You can get much more information about artificial insemination in this link: Artificial insemination (AI): What Is Artificial Insemination (AI)? - Process, Cost & Types.

In vitro fertilization (IVF)

As the name suggests, the union between the egg and sperm in IVF takes place in the laboratory, in vitro. For this, it is necessary to perform an ovarian stimulation on the patient and obtain the eggs by follicular puncture. Subsequently, these eggs are placed in contact with a previously obtained and prepared semen sample, so that fertilization can take place.

The embryos generated after fertilization remain in culture for a few days, to finally transfer them to the woman's uterus in order to produce pregnancy. Generally, it is decided to transfer a single embryo in each embryo transfer, so if there are more embryos of good quality, they can be vitrified for future transfers.

IVF is indicated in female infertility before:

  • Problems in the fallopian tubes (tubal factor).
  • Low ovarian reserve.
  • Advanced maternal age.
  • Endometriosis

IVF would also be recommended when there are previous failures of artificial insemination (AI) or EOD.

The cost of IVF is usually between 3000 and 5000€. However, it may vary depending on the tests needed and the fertility clinic. It is important to say that the price of additional medication is usually excluded from the budget.

ICSI

There is a variation of conventional IVF. This is the ICSI technique or intracytoplasmic sperm injection, which involves greater intervention by the embryologist. The whole process is identical in both cases, except that in ICSI the union between egg and sperm is performed by microinjecting the sperm directly into the oocyte.

This advanced in vitro fertilization process is especially indicated for severe male fertility problems. However, ICSI is generally displacing the use of conventional IVF. In addition, ICSI is the technique of choice in the event of previous failures of conventional IVF and when a preimplantation genetic test (PGT) is to be performed.

If you are interested in more information about IVF and ICSI, you can click here: In vitro fertilization (IVF): What Is In Vitro Fertilization (IVF)? - Process, Cost & Success Rates.

Ovodonation

This assisted reproduction technique consists of using the oocytes of an anonymous donor instead of the patient's own oocytes. This type of technique involves the patient renouncing that the embryos and, therefore, their possible future children, carry her genetic load.

However, there are occasions in which the problem of female infertility prevents the use of the patient's own oocytes (for example, in a woman who lacks ovaries) or in which assisted reproduction techniques have a very low success rate with the patient's own oocytes (for example, if the maternal age is advanced).

Ovodonation is one of the most expensive assisted reproduction treatments. Its price can vary between 4000-9000€, depending on the fertility center.

If you want to read more in depth about ovodonation, you have much more information in this article: Donor-Egg IVF Procedure for Recipients - Protocol & Cost.

FAQs from users

What are the main female infertility tests?

By Dr. Joel G. Brasch (gynecologist).

The main female infertility tests include:

  • Blood test – Day FSH and E2, Anti mullerian hormone (AMH), TSH, Prolactin
  • Tube test – Hysterosalpingogram
  • Pelvic ultrasound with antral follicle count

Is it possible to have assisted reproductive treatment for female infertility in a hospital?

By Silvia Azaña Gutiérrez (embryologist).

Yes, currently in Spain a woman (or a couple) can access assisted reproduction treatments through Social Security.

However, there are a series of requirements that must be met in order to be able to access these treatments through Social Security. These requirements may vary slightly between the different autonomous communities and generally have to do with age and the number of previous children.

Is there any surgical treatment for female infertility?

By Silvia Azaña Gutiérrez (embryologist).

Yes, on some occasions surgery may be necessary to increase a woman's chances of becoming pregnant, or prior to assisted reproduction treatment.

In certain cases of endometriosis, fibroids, adhesions, etc., the specialist may consider surgery to be appropriate.

Tubal surgery is rarely performed, as it is more common to resort directly to in vitro fertilisation (IVF). However, in the case of hydrosalpinx, it seems that its removal by salpingectomy (surgery to eliminate the fallopian tube) prior to IVF improves the possibility of pregnancy.

Are there any natural treatments for female infertility?

By Silvia Azaña Gutiérrez (embryologist).

There are natural remedies, such as a healthy lifestyle, maintaining a healthy weight and eating a balanced diet, which can improve female fertility. However, there are certain female fertility problems that cannot be solved naturally and it will be necessary to consult a reproductive specialist to determine the best treatment to achieve pregnancy.

Suggested for you

If you want to learn more about the female fertility study, you can visit the following link: Female Fertility Tests - How Do You Know if You Can't Get Pregnant?

If, on the other hand, you are interested in the treatment of male infertility, we recommend you read the following article: Treatments for Male Infertility.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Babayev SN, Park CW, Bukulmez O. Intracytoplasmic sperm injection indications: how rigorous? Semin Reprod Med. 2014 Jul;32(4):283-90.

Bosch E, Espinós JJ, Fabregues F, Fontes J, García-Velasco J, Llácer J, Requena A, Checa MA, Bellver J; Spanish Infertility SWOT Group (SISG). ALWAYS ICSI? A SWOT analysis. J Assist Reprod Genet. 2020 Sep;37(9):2081-2092.

Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J (2000). Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet; 355: 13 –18.

Haddad M, Stewart J, Xie P, Cheung S, Trout A, Keating D, Parrella A, Lawrence S, Rosenwaks Z, Palermo GD. Thoughts on the popularity of ICSI. J Assist Reprod Genet. 2021 Jan;38(1):101-123.

Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llàcer J, Bernabeu R (2004). Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril;81:1308 – 1313.

O'Neill CL, Chow S, Rosenwaks Z, Palermo GD. Development of ICSI. Reproduction. 2018 Jul;156(1):F51-F58.

Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Electronic address: asrm@asrm.org. Intracytoplasmic sperm injection (ICSI) for non-male factor indications: a committee opinion. Fertil Steril. 2020 Aug;114(2):239-245.

Ragni G, Somigliana E, Vegetti W. (2004) Timing of intrauterine insemination: where are we? Fertil Steril;82:25 – 26.

The ESHRE Capri Workshop Group (2009). Intrauterine insemination. Human Reproduction Update; 15 (3): 265–277.64

FAQs from users: 'What are the main female infertility tests?', 'Is it possible to have assisted reproductive treatment for female infertility in a hospital?', 'Is there any surgical treatment for female infertility?' and 'Are there any natural treatments for female infertility?'.

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Authors and contributors

Dr. Joel G. Brasch
Dr. Joel G. Brasch
Gynecologist
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
Embryologist
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV

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